Above: QUT’s Professor Lindy Willmott and Associate Professor Ben White
By Yasmin Noone
To provide treatment and prolong a life that may have otherwise ended or to withhold treatment and allow death to take its natural course – that is the question which medical and aged care professionals face on a daily basis, yet receive very little evidence-based guidance on.
In attempt to fill the research void which currently exists around this topic, Queensland University of Technology (QUT) will undertake a study into why futile medical treatment is, at times, provided to dying patients.
The study, due to officially start early next year, will be conducted by a cross-disciplinary team of academics from QUT and the University of Queensland, in partnership with the Royal Brisbane and Women’s Hospital.
The research, lead by Professor Lindy Willmott and Associate Professor Ben White from QUT’s Health Law Research Program, aims to reveal why treatment – which is considered unnecessary from a strictly medical point of view – is sometimes provided when a person is dying.
“It’s a topic that people have been talking about for some time but there’s not a good-evidence base on the extent to which futile treatment is being provided,” said A/Prof White.
“There is some overseas evidence – not a great deal though – but none from Australia.
“There is however, anecdotal evidence. Doctors in Australia are starting to talk about this issue…So this study will ask, what does futile treatment mean, how often is futile treatment occurring, why is it occurring, and how much does the provision of futile treatment cost the Australian health system?”
From a legal perspective, A/Prof White said, it is essential that health and professionals know what constitutes “futile medical treatment” and what the legal ramifications are when providing it.
“It is [also] the case that if health professionals provide treatment which patients or [other] decision makers have validly refused, certain legal ramifications will flow through.
“…Yet if someone was not refusing treatment but overtreatment was taking place, providing treatment could be regarded as a breach in a professional’s [legal, ethical and clinical] duty of care. But I am not aware of a case in Australia where that has been tested.
“…More importantly, from a patient-care perspective, assessing when treatment is futile is a good thing for professionals to be doing. Sometimes treatment can continue without helping the person. [Often], a patient arrives at hospital and they are given treatment, without doctors stopping to think if it is futile or not.”
A/Prof White said the provision of futile treatment could be linked to family requests for treatment; the absence of an advance care directive or conversations about end-of-life care; or the fact that medical professionals look at “individual pieces of the patient, not as the patient as a whole”.
“These are some of the issues which we might look at that may impede a person’s ability to have a good death.
“One of the [issues] with the provision of ongoing, burdensome, aggressive treatment is that it will not [lead] to the patient being referred to palliative care. If the patient is receiving futile medical treatment, then palliative care is not being utilized.”
The study, Futile treatment at the end of life: legal, policy, sociological and economic perspectives, has been allocated $260,000 from the Australian Research Council.
The research is due to be conducted in three stages. Stage one will incorporate a legal and policy document review, to provide the sector with a greater understanding of the regulatory context in which futile treatment may be provided.
Stage two is set to involve a series of in-depth interviews with doctors in hospitals, where researchers will investigate how their end-of-life care practices, and how they define futile medical treatment and why.
“The third part of the study will be to undertake some chart audits of patients who have died during a certain time period. We will look at their charts to see if futile treatment is being provided, at what point does the treatment get regarded as futile, why is it provided and the cost of the treatment.”
A/Prof White believed that results of the study will provide an evidence-base to support better decision-making about treatment at the end-of-life; help doctors identify triggers for when futile treatment might be provided; and increase appropriate referrals to a palliative approach.
“At the moment, we think there is a problem with people receiving treatment that may be regarded as futile or not wanted.
“But we don’t know the extent of that problem, how it occurs and why.
“Hopefully, through this research, we will develop a better understanding and an evidence-base which is needed to answer those questions.
“And, from that, we will be in a better position to [empower medical and aged care staff] to have conversations with patients about what is appropriate treatment and avoid the triggers of providing treatment that a patient does not want.”